Provider Demographics
NPI:1013923580
Name:COEN, MARTHA JOHNSON (LISW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JOHNSON
Last Name:COEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 GREENWOOD PKWY
Mailing Address - Street 2:305
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2397
Mailing Address - Country:US
Mailing Address - Phone:330-467-0126
Mailing Address - Fax:
Practice Address - Street 1:12429 CEDAR RD
Practice Address - Street 2:2
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3199
Practice Address - Country:US
Practice Address - Phone:216-721-1407
Practice Address - Fax:219-491-7784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-3166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health